Spinal subcutaneous node cold abscesses commonly penetrate into the lungs, while penetration into hollow organs such as the esophagus, thoracic aorta, psoas abscess into the appendix, gallbladder, colon, and bladder is relatively rare. As a result, they are often misdiagnosed or mistaken for fistula disease in clinical practice. This is presented for the reference of clinical practitioners.

bubble_chart Pathological Changes

Cold abscess is an important component of the pathology of subcutaneous nodes in the spine. When the bone lesion is in the acute phase and dominated by exudation, the abscess rapidly enlarges. At this time, the pressure within the abscess cavity also increases, causing the abscess to rupture through the weak points of the cavity wall. The caseous material and granulation tissue from the subcutaneous node sexually transmitted disease lesion infiltrate and spread locally, penetrating adjacent organs to form an abscess-organ fistula.

1. Abscess-esophageal fistula: The esophagus is relatively fixed, lacks a serous membrane layer, and has fragile muscle layers, making it susceptible to penetration by cold abscesses, though this is rare. Clinical reports include one case by Roaf (1959), two cases by Kyhenok (1972), and one case by the author (1980).

2. Abscess-colon or rectal fistula: The ascending colon, descending colon, and rectum have limited mobility and are relatively fixed, adjacent to the psoas muscle abscess. Therefore, abscess penetration into the colon is more common than into the highly mobile jejunum or ileum. Among Kyhenok's 21 cases of abscess penetration into hollow organs, 11 involved the colon. The author reported two cases involving the colon and one involving the rectum (1980).

The nature of the pus discharged from the fistula may have a fecal odor, and the diagnosis can be made based on endoscopic examination, X-ray fistulography, and barium enema examination.

bubble_chart Treatment Measures

Preemptive subcutaneous node treatment, controlling restriction and generation of purulent infections, and other non-surgical treatments may lead to the cure of fresh abscess-organ fistulas. For those that do not heal over time, surgical intervention should be performed, with sensitive drug therapy for purulent infections during the perioperative period. During the removal of spinal subcutaneous node lesions, surgical repair of hollow organ fistulas should be performed simultaneously during the seasonal epidemic; alternatively, bone lesion surgery and organ fistula repair can be conducted in stages.